Morettia2

See the thing is....I didn't become cocky, I was sick of being verbally beat down. One can only handle so much insult. You reach a breaking point. And I broke. I had enough, and I wasn't about to be treated like a child. Yes I was there to learn, but how can you learn when the person teaching you constantly berates you. It's been almost 2 years since I posted this and the "hazing" just started to subside. I am proud to be a CTICU nurse and I can say that I learned more when I was unchained from my preceptor. Yes, she was very intelligent, but I am a person and I deserve to be spoken to like a human being. But that's in the past and I have moved on.

I have worked at the same hospital for about 5 years. I started out as an Interventional Cardiology RN right out of school. I became one of the Night Shift Charge Nurses and was offered a position as Nurse Manager in the Interventional Unit. At the same time I was offered the ANM position I had applied for a job in the CTICU in my hosp. I have a great working relationship with the MD's and RN's on the night shift in the CTICU from being pulled to the CTICU SD over the years. Let's just get one thing straight, my ultimate goal as an RN was to be hired into the CTICU. Not the CTICU SD but the CTICU. It was my dream. I got the interview, and when I was offered the position in the CTICU I started crying. I knew what job I wanted right away. I had burned out on the Interventional floor. I had precepted, had been one of the charge Nurses and I felt I wasn't being challanged anymore. My co-workers were so excited for me and said they would miss me and we cried ALOT. I reminded them I would only be 2 floors away. I start my orientation in the CTICU and meet my preceptor....my first thought was, I am so excited to be here and I can't wait to learn and build on my knowledge base from the Interventional unit. But I had also went from working 4 and a half years on night shift and suddenly was being oriented on day shift. No big deal I can adjust. Plus the position was for night shift, so I would go back into my routine in no time...so I thought.... So it starts......the one thing I said to my husband was, "I hope that this orientation goes well and isn't like the nightmare orientation I experienced years ago." He said, "You know what you are doing this time around, and you know you are a great nurse, or you wouldn't have been offered 2 jobs." Yea welcome to my nightmare....but this time around I had experience under my belt. So I start in the CTICU, my preceptor came across very excited to teach me. Great that's what I wanted.... So my first week I was bounced to another preceptor who was amazing, she knew who I was and let me work and was an amazing teacher. But week 2 came and I was bounced back to my original preceptor. Then my decent into the abuse abyss began. I was scoulded like a child, I am 31 years old. I was told that I didn't know how to properly put a BP cuff on the pt, ahhh excuse me.....I do believe I just taught you how to use the new monitors and how to activate the screens to be able to read the BP...and I did pick up a thing or two when I was IN CHARGE of the Interventional Cardiac Unit for the last few years. I basically bit my tongue and grinn and beared it for a few weeks. I wanted to learn, but when you are constantly belittled and placed in a position of being treated like a child you tend to shut down. I would ask questions and be spoken to like a 3rd grade student. I would come into work in the morning, now remember I worked nights for years, it would take me a few to adjust in the AM. I was told I don't care, I am irresponsible, and that I should realize that it is a privlidge to work in the CTICU. That this was the most prestegous job in the hospital and how I didn't appreciate that........UMM yea you crazy beast This was my life dream working in the CTICU, I know b/c I cried when I got the job, but now you are making it a living nightmare. I finally came to my breaking point. I had a pt. who told me, "don't let that woman following you into my room. She is mean and she talks to you like you are not human. She yells at you for nothing and you are running around in circles while she sits on her hide, how are you susposed to learn when you are being yelled at for every minute thing." The next day I went to my educator, I explained what was going on, and had a meeting. I thought things would change and for a few days they did then........I had enough, I was being told how I wasn't putting an IV in right, I have put in countless lines over the years in fact they don't know how to put in lines in the CTICU b/c everyone has a TLC, I just turned and walked out of the pt's room and said "this isn't my first time on the playground, I was offered an ANM position, I was runner up for employee of the month, a night shift preceptor, and one of the founders of the TCAB program. I am not a new nurse that you can beat down, I want to learn and you just keep grinding me into the ground, and by the way the pt. has 2 fresh lines I just put in while you walked out of the room, so don't ever tell me how to insert and IV ever again." Standing there was one of the MD's who I have been friends with for years, he turned to her and said, "Ang can get a line in anyone, and she is a great nurse that's why I reccomended her for this floor, but you don't let her speak or give her a chance." I think daggers may have been shooting out of her eyes at this point. And the worst part was all of my friends on nights in the CTICU were like, "Just get through it then you will be with us....we know how upset you are.." Infact some of the day shift and the night shift RN's and CNA's went to my director about the way I was being treated.... LESSON LEARNED for the second time in my nursing career "Note to self, no more preceptors..", ....my orientation was 3 months......I have beeen off orientation for almost 6 months, but have been a cardiac nurse for 5 years. I swear I attract crazy. I have no hard feelings toward her. I know Karma is a witch!!

I have one...this wasn't a Nurse but a DOCTOR who did this......Here it goes, you guys are going to love this one, it was about 4 years ago..I was probably about 1 year into my nursing career as an RN, I used to work on an Interventional Cardiology unit. So the pt. was a case from the cath Lab s/p AICD insertion. The nurse manager recieved report from the cath lab at our change of shift at 7pm, which was normal to get report from the cath lab before the case came to the floor during change of shift. Ok the pt had AICD insertion...blah blah blah blah....Any drips? No but the pt will recieve Ancef 1gm but we will hang it when we bring the pt up( Ancef with in 30 min of AICD insertion for profaltic ATBX which is pretty much universal protocall in our hosp)....any allergies....NKDA....pt. is spanish speaking only but our Anestiaologist speaks spanish so he did the H&P and so on and so forth....So the ANM said ok the room is ready bring the pt. up....so about 5 min later the pt. arrives on the floor. We get the pt. situated in the room, Myself and a few others are doing EKG's putting on the monitor ect, and getting the CXR and I have always done this, ALWAYS, I First check the orders and the H&P and the procedure notes as we are getting the pt. settled... and the one RN from the cath Lab spikes the Ancef and the IV is going and all of a sudden the pt. is in respiratory distress....The other RN's first thought was a pneumothorax from AICD placement..... OK I am anaphalatic alleric to PCN, so as soon as I saw the ANCEF was actually running I yell TURN OFF THE IV and get EPI NOW (I mean this was seconds from when the cath lab RN spiked and hung the bag) ....The family had come up with the pt. and they only spoke spanish too...I ran out of the room, and I speak enough broken spanish to find out that the pt is Allergic to PCN. And the family had told the Doctor that did the H&P and intake form that he was allergic to PCN. But he put on the chart NKDA. I called a code and the Anastesiaologist who was on the case in the cath lab and who TOOK the H&P came stomping in the room and was so miffed. He said while intubating the pt, yea he may have mentioned something about a PCN allergy but Ancef should have not caused the anaphalyxis. I turned to him and said are you serious? If the pt is allergic to PCN that should have been a red flag not to give ANCEF...he tried telling me that Ancef can be tolerated in pt's allergic to PCN. I said what you thought maybe some flushing and hives?? And why is there NKDA on the H&P and Intake form if you knew about his PCN allergy? He just yelled a bunch of curse words... I know the nurse doing the med rec asked the pt. if he had any allergies and the pt. said no, and the nurse spoke fluent spanish, but this was right before the cath, so most people are so nervous that they forget but she should have asked in depth medication allergies, food, ect...then most people respond....but the initial H&P by the MD was critical....and the family wasn't with the pt. when the RN was doing the med rec. in the cat lab holding area..and by the way this pt. had no past medical HX that we were aware of, and no primary MD that they could have referred.... Anyway to make a long story short the pt lived but let me tell you...from that day on any pt. with a PCN allergy, or any allergy, I had my nurses check the ATBX the pts were going to recieve. We were and still are very strict on allergies, but I made sure of that. And one reason is because, me who was a new nurse at the time, made sure that all of the RN's knew what drugs were associated with different allergies the Reason being I have quite a few med and food allergies myself and I just wanted my RN's to be very diligent and proactive no matter what the MD says!! Lesson learned!

OMG I haven't been on this site in a very very long time...I can't believe this post is still a sticky...I can only say, one year ago I posted this...since then it's been well...i am not going to go on a tangent..I have to be up in a few hours for work...but when I get the time, I will update you and well I am so overwhelmed by all the nurses I touched with this post!!! KEEP ON DOING IT, WE ARE NURSES!!!!!!!!!!

I work nights, I am far from weak. If I heard a Doc say that, I would fire back with, "well, since youthink we are weak, I would be prepared to expect an increase in pages b/t the hours of 12am-5am. And when you call back I will say, Oh I am sorry I must have paged the wrong Doctor." Night time in the hosp. does not mean that it's lights out and everyone sleeps. Half the time my pt's have no idea what time it is, and for some reason we have had a major influx of geri-tele pt.'s who are BAD sundowners. And for some reason our pt's always wait till late at night to tell us that they have a problem that had been going on all day, but didn't want to bother anyone during the day, so they tell us at odd times to say, "I have been having this chest pain all day but I figured I would tell you, b/c it's night and your not as busy as the day nurses..." ERRRRRRRRR...."No I just have double the pt. load at night. Day shift has 3 pt's, I have 6. I am not busy running all over the unit, not at all. And you know, at 2am I have access to a whole slew of MD's to help you (the house MD and the tele resident)....unlike the day shift. Oh and did you bother telling any of the 10 MD's that saw you all day long bout this chest pain you have?" No matter what shift u work, you are never weak. Hey nursing is 24/7...and if doc's wanna think night shift is weak, then they should remember if it wasn't for night shift then they would never know what happens in a 24hour period. We don't sleep, we work, period, no matter what shift you work.

haha thanks..I know it was a long post. And I thank you for reading it!!

Ok so I have been posting on here for quite a while, and alot of you have read my stickie...it get's better I PROMISE....and I thank you and I hope I have helped or encouraged you to keep up the good work. But I have to share this one, and the only reason I am doing it is because experience and my wit were the only things I had going for me. Let me tell you a little story about the other night. Saturday night I get to work, fine it's my 2nd night in a row, I got back the majority of the pt's I had the night before. No problem.... OK PROBLEM...I go to make my rounds. One of the pt's I had the night before, I went to say hello and to assess him. He tells ME, "ohh god I have been having this terrible headache and double vision for the last hour." I ask was the double vision new, he says yes. He said it's killing me...I take his pressure, its 180/110.....OK...he's already on a heparin gtt, and I am about to give coumadin 20mg...Holy crap that's alot of coumadin...I automatically called the cardiac MD service,call the tele resident, and the house MD for the night. I automatically gave him his procardia 60mg, Clonidine 0.1mg and tylenol 650mg at 8pm insted of 10pm. My fear was the pt. was going to stroke out. I get zero calls from any MD's. I begin my round of paging agian..finally I get the cardio MD on the phone. I tell him the s/s the pt. is having and what meds I gave. He told me to put in for a STAT head CT w/o contrast and to tell the tele resident to call himwith the results..I finally get a hold of tele resident to tell them what going on...the primary cardiac md said I did the right thing giving all the meds...ok...I put in for the CT of the head, and take the pt. down. ASAP..... yea.... I get back to the floor to call the tele resident to tell them that CT was done and to call the cardiac MD with the results asap...In the mean time the headache was gone, the pressure stableized and ok.... NEXT PROBLEM.... I am going to the next pt. room to say hi to the pt. and the over head page is going crazy with my name. I can't do one thing with out being paged....it's security asking if family can come up to see a pt, it's the nursing supervisor, it's god asking me if I am sane.... Finally I begin to assess my pt. and have to give a gravity peg tube feeding. I said to the UC to call the room if it is urgent b/c I am about to give a gravity feeding. I begin the feeeding, toomby and jevity, 200cc gravity bolus. I had the door shut while giving it, b/c I knew better then to be distracted while doing it and told people not to burst into the room....welll...hahahah...yea... As I am on the 3rd 30cc round of the feeding, I am paged in the room. It's the tele resident, I told her I would be out in a few min. and to stay there b/c I am giving a gravity peg feeding. NOOOOOO...the tele resident comes busting into the room startling me and making the pt. cough at the same time....JEVITY GOES EVERYWHERE...ALL OVER ME, THE PT, THE FLOOR...GROSSSSSS........ OK at this point I am covered in jevity and probably part of the pt's stomach contents.....i flush the tube...go out of the room and talk to the tele resident.... AT THE SAME TIME I am being called by the raidologist MD about results from a CT scan of the abd. that was done during day shift on the pt. with the peg. He tells me the results...I said, "Umm, you need to call the MD with the results" HE basically told me NO and blah blah blah blah and how I had to do it...I said very firmly "YOU are the on call raidologist MD, and YOU ned to call the MD. So pick up the phone call the operator and get the # of the MD who ordered the CT of the abd. if it's this urgent" and I hung up. Well...I know the MD who ordered the CT so I called him anyway. He called back asking why I was the one calling him with CT results...I said, "B/c the raidologist MD on call won't call you. SO here's what he told me, and here's his name." So about 20 min. later the same blastin raidologist called me agian with the results of the CT of the head my pt. with the uncontrolled HTN had...I said , " CALL THE TELE RESIDENT, here's the #"....I called the tele resident anyway to CYA....OMG....the resident was telling to me call the cardiac MD to tell him the results, I said, " I am not the MD, you are, I told you that you had to call him back with the results of the CT scan of the head., SO CALL HIM, he won't bite", but I put a page out to the cardiac MD to CYA.... IT GET's MUCH BETTER.... SOOOOO I have 4 pt's and I have to admitt 2 more...no problem I never got the ER report for my first admitt b/c of all of the chaos.... The pt. arrives...she passed out at the airport, came to the ER, was in the ER wnt outside to the ambulance bay to have a smoke and passed out agian...38 y.o. female...has a basilar skull frx, stitches to the back of the head and on the back. Comes with a EEG monitor to my floor.... UPON ARRIVAL...she begins freaking out....climbing the walls literally. Speaking both perfect english and chinese...I call the resident for a 1:1 order and an auto psych consult as per policy.... I asked if she was speaking manderin or cantonese?? she said something then cantonese... SHE THEN GRABBS ME, AND CLAWS ME IN THE POSTERIOR PART OF MY RIBS in my back ON THE LEFT SIDE. She gives me a GOOD JAB. I just lost it... I began screaming for help...she was out of controll... The resident calls me back telling me that they won't sign the 1:1 order...the pt. was a service pt. so it was their resp. to sign the order...the resident and her senior resident begin telling me how they won't do it b/c if something happens to the the pt. it's their responsibility..... I LOST IT.....I SAID, 'I AM LOOKING OUT FOR THE SAFETY OF THE PT., THAT'S MY RESPONSIBILITY, SO GET YOU BUTTS(didn't use that word), AND SIGN THE FLIPPIN ORDER. I already called in a psych consult so JUST SIGN IT" I just went into super nurse mode...I began calling the nursing supervisor, the house MD, the psych MD again...the ER nurse manager who sent the pt. to me.... I got the night shift nursing supervisor on the phone and well...let the fury loose......told her about the resident, the raidologist who won't call MD's, how the pt. assaulted me, how NOT A SINGLE MD WAS doing anything..... Well with in 2 min I had 5 MD's on the floor. and the psych md called back..I got an order for thorazine STAT.... Funny b/c the EDP(emotionally dis. person)'s IV was blown so on top of it all I had to put a new IV in. That's when the pt. told me, "you have NOOO Idea how I used to hurt my self when I was younger..." I saw all the cut marks all over her.... And I got the psych md at 1:30am the psych MD came in and eval. that pt. only to tell me to d/c the 1:1 order.....I said , "are you kidding me...LOOK AT THIS!!!!!!!!!!" I lifted up my shirt and showed him the giant bruise the pt. gave me.....she mayhave hit her head but she didn't forget how to fight..PLUS she told me how she used to hurt herself" I convinced him to keep the 1:1 order.... After all the chaos I begn going through the orders from the ER...I saw in the notes howw she assaulted a nurse, had a 1:1 in the ER....I was never told....I was soooooo MAD.... SOOO I GET MY NEXT ADMITT...I was told, actually promised, that this one was ok...WRONG...CONFUSED, with a 1:1..... needless to say in hindsite...if i was a brand new nurse I probably would have really flipped...but I know now that my exp. is making me stronger..I fillled out multiple incident reports, didn't back down to the MD's and did my job... you will come a long way I promise...

god-is-love, when you start out as a new nurse it's like being on mars, kind of. My story is this...I am from the philly burbs. I went to the University of Scranton in 98-2002 and graduated with a B.S. in Criminal Justice and a minor in Sociology. When I graduated I couldn't find a job, I wanted to be a police officer or go back and get y masters in criminology. But the job market was horrible in 2002, I had taken numerous law enforcement exams, federal, state and local. But nothing.... So I ended up working at my parents hair salon, being the salon manager. I hated the fact I was working for my parents but was grateful to have a job. I looked day and night for a job, any job. I found a job in T.V. production. It was for a traffic coordinator for Infomercials. I went for the interview and got the job on the spot. OK, I had a love hate relationship with this job. It was a family owned business, ok I know what that's like from my parents hair salon. It's a family atmosphere.... I began working and realized I was making NO money but I was getting awesome exp. in broadcast and marketing, which I knew nothing about, other than the fact I used to watch infomercials all the time in college when we would be up late or all night...drinking and 4am infomercials...hahaha..anyway. The company that hired me was well known and respected, but the owner was a cheap shister. He drove a porshe, blew money on the most rid. stuff and payed his employees terrible. He was around about 20% of the time, and a total train wreck, he would make us start projects that were the most pointless things I have ever seen, like making me reprogram all of his cell phone numbers from his old phone into his new phone...YEA...theycan do that at the cell store.. But the only good thing was the people who worked there. It was a family owned business. The owners wife was actually co-owner and like a 2nd mom to me. There were 2 daughters, around my age at the time, which was 22, and their brother, who actually ran our west coast company untill they made the decision to shut it down. The brother, after he came back from Cali., became my boss, and he used to say I was like their adopted sister. He was also the big brother I never had. I was the one who told him to marry his, now wife, who is a cardiac nurse, after their 2nd date. Anyway I worked there for 2 years. I learned alot, I mean alot, how to deal with pushy clients and media buyers. I learned the business of TV and broadcast and became traffic manager, which I should have been paid 3 times what I was being paid according to some of our clients. After being WAY WAY underpaid for about 2 years, I found a job through one of our clients. In the meantime my boyfriend, who is now my fiance, became a police officer for the NYPD. My turning point to becomming a nurse was this, if anything happed to my fiance while he was on the job I would want to be the one to take care of him, and then there was this...my fiance and I were in Atlantic City for a weekend. We went to one of the clubs, and after drinking and dancinbg all night we sat down on a couch and there was this girl passed out next to me, but had noticed her earlier in the night with some friends and the friends left her b/c she was taking to some guys and she was drinking water. Now some shady dudes were trying to get her to leave with them. I just turned my head, asked her name, she told me, although she was semi-conscious. I asked the shady guys what her name was, they had no clue. I acted like she was my friend, and they eventually left. But in the mean time, she was getting worse by the minuite. It wasn't like a drunk semi-conscious but like a drugged semi-conscious..I know know but that instinct kicked in..I began counting her respirations, and this was in dark club. I just put my hand on her back and began counting her respirations, it was b/t 6-8 a min. I was asking her simple questions like do you know where you are? ect...I took her pulse, it was 40...now I wsn't even thinking about nursing school yet, but knew enough to see some one in trouble. I made my fiance grab a security guard and he came over and I told himand he ignoed us. I finally grabbed the head of security and told him what was going on and also told him her pulse and respirations. I said this was the water bottle she was drinking out of. He took it gave it to the ACPD that was standing out side the club. I said how the first security guard ignored us, and said she's probably just drunk. The head of security and the ACPD called the paramedics. She was unresponsive at this point. I had a pen light my aunt, who is an er nurse manager, gave me to have in my purse for when it is dark outside. The security guards and cops only had those big MAG flash lights, no good for pupil response unless you want to blind the person and yourself. While te medics were in their way I checked for pupil reaction, with my pen light, they were sluggish. The medics arrived and took her. We went back to the club the nxt night just to talk to someone to know what happened. And the cops who were there the night before were outside. I asked them what happened, they said she was roofied and ghb was put in her water. She didn't have an ounce of ETOH in her blood. They asked if I was a nurse or a paramedic. I said no I wasn't. They said if it wasn't for me they don;t know what would have happened to her. OK here's the kicker...after that night, I knew I had a calling and I began the rapid research on nursing schools in my area. I picked my local community college, which is one of the best nursing programs on the east coast. I barely made the deadlines. I had to take the NET test, most people have months to study for it, I had 2 days to study for it. The nursing recruiter said can you do this in 2 days? I said yes..2 days later I took the test. Now in the mean time I was preparingfor a job interview for one of the broadcast clients I worked with. My life was split, and it was I swear to god, or who or what ever, that fate or destiny stepped in... I got the letter 2 days after I took the NET test that I passed with a scorein the high 80's. I was given the option to choose day program or night and weekend program. I chose night and weekend so I could still keep my job. About 1 week later I had a job interview with a huge media company. It was a hughe position. It was a 3 hour interview. After the interview I got home and saw this letter from the community college. I opened it and it said I was waitlisted to the night and weekend program, it even ranked where I was waitlisted, I was #18. I was a total lunatic. Also right after I opened the letter I had a call back from the interview I just left asking me to com bcak in the next night for a 2nd interview. NOW MY FATE...the next day I was on my way to the second interview and in the car I got this chill down my spine and a little voice in my head said call the college and ask if there are any seats open for the day nursing program. I made the phone call. The nursing recruiter said, "Ang I was just going to call you, you read my mind, there is one seat opn in the day nursing program, do you want it?" I just blurted out YES YES YES...now this is as I was oulling into the parking lot of the compant I had the follow up interview for. I went in to the interview, the woman who interviewd me just grabbed me as I walked in and said, "ang you are perfect for this position, I have interviewed 100's of job applicants but you are it, here's what you will be makin a year, it is about $60000 or more. We want you to start immediatly, you will have your own team and be DRTV broadcast manager." I jut stood there and had to make the most important decision of my life. Do I go back to school, get a job that pays crap just to get me through school and that's if i make it through school and end up doing something I was meant to do, or do I take this job, and if i take this job I won't see my boyfriend, now fiance, ever b/c we live in different states, but have my first REAL job..... I said to her, "I am so sorry to tell you this but on my way here I was just accepted to nursing school. I was offered the last seat in the program. This is probably the hardest decision Ihave ever had to make, and I hope I don't regret making this decision, but I decided to go back to school and accept the nursing school seat. I am so sorry." She just stood there and said, "but you were the ONE, I called all the regional offices and told them about you. But you know what, my mom was a nurse, so I know you must be excited. So listen if nursing school dosen't work out, you just call me and tell me. Here is my card, and keep in touch. remember you have have a job waiting here for you no matter what." She gave me a hug, and said congrats and that she just lost the bes potential DRTV broadcast manager. I still keep in touch with her. She always tells me that if I want to leave nursing I still have a job waiting. I went back to school, and I worked my tail off. got a job in the library at school, making like next to nothing but it was a job, and I worked through school. When I passed my final exam I cried. cried at pinning in may of 2007. When Ipassed my boards in july of 2007, and became an R.N I cried. And when I had my hosp. job interview,after I cried. I impressed the unit director so muc with my answers, eventhough I thought i blew the interview b/c I had an asthma attack in the middle of it, I recievd a phone call an hour after the interviw was over to tell me I got the job, Interventional Cardiac R.N. and started a month later. In that month I moved from Philly to NYC to live with my fiance. We found a great townhouse to live in. I started my new job in NJ, I didn't know a soul. I met a girl in orientation that had moved fom indinana to statan island, and we both worked in NJ at the hosp. bvut on different units. Well, she is one of my best friends. She left the hosp. last year though and moved VA. b/c she hated our hosp, as did I at the time. But I can say, like I have said a million times before on this site. It was awful at first. I was a TOTAL outsider when I started, I was from Philly, I was a new RN starting on an Interventional Cardiac/CCU step down/ pre and post heart transplant floor. I was abused with awful, pt. assignments, didn't know how to stand up for my self as a nurse yet. MD were intimidating, my co-workers were down right rude and ignored me. Also I didn't have a great orientation at all. I learned ALOT, and I MEAN ALOT on my own. I was pulled to the ER my 2nd week off of orientation, which has never happened ever, to any new grad off orientation at the hosp, you are not susposed to be pulled untill you are 6 weeks off orientation.. I even got an award for that one, literally. I was verbally threatened by a Doctor like my 2 or 3rd night off orientation, who wanted to "have my license", b/c I called him 20 min. after he evaluated the pt. to tell him the pt. was having chest pain. It was like 2140 or 2220 at night, and was right after he did the H&P, like 30 min. after the MD had left the pt. began to have crushing chest pain. YEA that MD went to the HEAD of the HOSP and tried to have my license taken, the head of the hosp. said, "Hey doc, it's your pt. and your responsibility. She is the nurse and she did her job, and she did it well, you are the primary physician." I always say karma is a bit@#. I ended up having that MD, who "wanted my license" as a patient a few months ago. He was admitted to my floor and of all the blastin nurses, they picked me to take cae of him b/c they all said, "it's payback time, ang, it's been a year since he did that to you" I just said ,"he's just another pt. to me, and he's sick so that's why I am here I am his nurse, yea karma def. bit him in the butt and took a huge chuck out, but I am his nurse an he needs me." When I walked into his room for the first time, and said "hi dr.XYZ, I am going to be your nurse tonight" He just looked up and had this blank expression. HAHAHA..I took care of him a few nights in a row. But in the end he ended up sharing some wired fruit from his country with me and now every time he sees me he always says what a great nurse I am... I mean you grow into your own, you find a voice and develop your style of nursing. I started out timid, yea I was NEW, what new nurse isn't intimidated by the 3 ring circus at the hosp. I developed my style of nursing and my nursing persona. I am the go getter, the one every one comes to for advice or pt. evaluation, but when I frist started I was always told I was over reacting untill they began to notice that my over reacting was for a reason, it's called being a nurse. I have delt with my fair share of rude and piehole MD's, that try and intimidate me. At first I was, but now I just say, "hey I am the nurse I report s/s and objective observation, you are the MD, you diagnose." I had one MD bark in my face abou how I didn't see the pt. was in pulmonary edema. I said, "yes I did KNOW, b/c the pt. sounded like he was drowning. I calld the RESIDENT to eval the pt. And I suggested differnt meds and tx to YOUR resident, but was ignored. and I am sorry, a CXR was done as per my idea, but ordered by the redident only after I suggested it. The resident read the CXR and said the pt. ws fine. I am a NURSE, i know Pul. edema looks like a butterfly on a CXR, I said that, but your resident didn't agree. I do my job and I do it well. It's not my fault that the night MD's and DO's don't know what they are doing, but it's all we have to work with at night for objective eval." I mean I have had MD's rant and yell on the phone, I said to one who went on a 5 min tiraide, "OK are you done yet? did you get it all out? b/c I need this order now"...everyone just looked at me like i can't believe you just said that to him...I say, "he/she is not god, they are human, people like you and me, they just like to yell at the nurse. They have that MD or DO after their name for a reason they chose to be a doctor, and if they don't like 3am phone calls for orders then that's tehir problem, and as nurses we are only doing our job... TAKING CARE OF THE PT., so when that pt. wants tylenol or mayloxx at 3am and house staff dosen't cover their servce, then you better believe I am going to call and wake their butt up. I am here for the pt., hence the reason I am a nurse and as an pt. advocate I want what's best for the pt." Nursing is stressful, but very rewarding. It seems like you ma have more bad days then good days, but there is always one pt. who thnks you for everything you have done. An even on the bad days or nights, always do you job to the best of your ability. It will only make you stronger. Ok enough typing...but if could make it through my first year and survive, so can you. I am comming up on 2 years. I am a good nurse, and as long as you remeber why you became a nurse, you can make it. Smiles, hugs, handshakes or een jut a look from a pt. can make all the difference.

HAHAHAHA you don't know how many times I wish I could have said that...hahaha..

I am glad to hear that everything worked out... I am an RN working in an innercity hosp. Every so often we get called off when our census is low. Last week, I was called at about 5:45pm by the day shift charge nurse, to tell me I had PTO for the night. I was just getting up anyway to shower and get ready but since I was given PTO I wanted to wake up, have a cup of coffee and talk to my finace and my future inlaws...I was thrilled. My fiance just had major surgery and I was taking care of him so it was very conveinent. I was also at my finace parents house, I slept there in b/t shifts b/c he was staying there, rather than our townhouse. So I went down stairs, told my fiance and my future in-laws I had PTO for the night... About 20 min later I get a phone call from the staffing office at work...stupid me Ipick up the phone and they tell me it's no longer PTO but conditional PTO, so I am on call untill 11pm. Ok fine..about 3 min later I get another phone call from the staffing office telling me I have to come in for my regular scheduled shift 7p-7a. OK.... Now I call my floor b/c I was annoyed at this point and it was almost 6:30pm and my shift is susposed to start at 7pm. I taked to the charge nurse, she had no idea staffing was calling me telling me to come in and my PTO was cancelled and that I had to work.... I said, "thank god I am at my fiance's parents house which is only 20 min away from the hosp, and not our townhouse, which is 50 min away. but I am going to be late b/c I have been playing musical phone calls with staffing...so sorry but it's not my fault that I was told I have the night off then told I am on call then told I have to come in. So I will be there by 7:30pm...." I got to work and well what a waste...it trns out they didn't need me at all but I said, " I am here, I already had 2 huge cups of coffee, I am going to work so figure out my assignment and no worries. " But this sort of thing happens all the time on my floor. I can't tell you how many phone calls I have gotten telling me I have PTO for the night, then with in 10-30 min later I get another phone call telling me I am on call, then another phone call telling me to either come in or stay home... It's fine if I am being told I am on call, b/c I can be ready...but when they mess around making 3 or 4 different ohone calls teling me different things I get mad b/c I live about an hour away from the hosp. I have gotten to the point when I say, "you know I live about an hour from the hosp, so when you do this last min. come in nonesene, after being told I have off, I am going to be late. When I am on call everyone knows I will be there ASAP, BECAUSE I AM ON CALL. But this calling me and telling me 3 or 4 different things has to stop." It will never stop, but hey I became a nurse for a reason so I guess I am just happy to have a job.

I just wated to tell you, your story sound similiar to mine..I will post more later gotaa go back to work in a few hours but if you ever need to talk just send me a message

Hey guys just got my evaluation for the year, last year I was new so it was a prewritten evaluation..this year I got to score my self, self evaluation before my night shift Nurse Manager gave me what she evaluated about me. Well, let's just say that we use a scale of 1-5...I scored a ton of 4's and 3's on the evaluation from my Nurse Manager at night. She said she has never given so many 4's on an evaluation for a new nurse, meaning under 2 years exp. She also said she is trying to nominate me for a junior registered nurse of the year award. She said that I have improved and excelled more then any other new nurse she has ever seen. She said that I still get frustrated with certain things, I made her name an example(s), she did, and then she also said that no matter how much exp. nurses have they still get frustrated with things. I also pointed out the situations in her examples and why I get so frustrated and no matter how much exp. you have as a nurse theses situations will make you frusrated, she agreed that I got and still do get heavy pt. loads but for a reason, and it may be intentional and unintentional, but she felt that challengeling me as a nurse with certain pt's makes me a better nurse. She also told me that my patient relation skills are amazing, and my objective and subjective assessment is incredible. I was floored that I scored 4's on my evaluation. She also told me that my aggresiveness and advotacy for the pt with the MD's has changed our floor at night. She said, "you used to be timid with the MD's last year and in you eval from last year in january of 2008, you were telling me how hard itwas to talk and make a point across to the MD's b/c you had only been a nurse for 6 months at that time. BUT NOW you make sure some MD, will listen and if they don't you keep calling, no matter what time it is and who you wake up in the middle of the night. You have no fear of MD's yelling at you b/c you fire back at them and you make sure your pt. is taken care of no matter what. She said that I am comming up on my second year of being an R.N. and she is very proud of me. She said that she's very proud of me... After that eval. I got home in the morning and called my mom, my aunt(who is an ER nurse manager, and my mentor in nursing) and told them. My aunt was so happy, she said, "just keep excelling, and I can't believe you scored 4's on your eval. I am proud of you.." Comming from her that means the world to me.... So new grads you can do it! It takes alot of literal blood, sweat and tears but being a nurse is something we choose. And well it's a love/hate job, but those little moments change our lives!!

OMG I work in Newark, NJ and we get the worst of the worst. Low income area where my hosp. is located. The pt's that are admitted to my floor with cardiac problems are so unbearable at times. There was one pt. in particular last week. Great guy, young guy but heary transplant rejection and morbidly obese, but very friendly but had the worst aroma. YOu could smell it as soon as you walked into the back part of the unit. I would walk into his room and I had that gagging sensation from the smell. But I maintained being a professional and didn't make a face. He was for TEE on the following day, so Iwas determined to strongly encourage him to was himself very well before I left in the AM...well the CNA was not so professional, she kept telling me, "HE stinks so bad that the other pt's are complaining, and I askd him if he washes and he told me he does, he's a liar..." I just said" calm down this is what you do, when you start your AM care at 4:30am, offer him a hot basin of H20 with lots of soap insted of just asking him to go into the bathroom and wash up b/c he may be too SOB to stand at the sink and do it, soo and as you offer him the hot soapy H20 in a basin ,start to fill the basin up with the hot H20 and soap and give him lots of wash cloths and towls and a big boy gown and just place it at his bedside table, even if he says he can do it him self in the bathroom, fill the basin anyway and I bet he will wash...and make sure you change all of his linens that will also help and I will get you some magic spray for the room, but if the hot soapy water is in the basin right in front of him and he has enought wash cloths and towls to dry it encourages him to washup, insted of just assuming since he can walk into the bathroom he can wash himself," I go into the room at 5:45am to give him his meds and what do you know he washed himself. The basin H20 was so dirty it was dark brown. The pt. said to me, "I overheard what you said earlier to the nursing assistant, I appreciate that you didn't talk about how I smell, I know I do and I apologize but it's hard for me to wash up but what you told the Nursing assistant to do this morning is the first time I have had a nurse care about me. And I thank you for the deodorant you gave me. I feel much better, and you are the only nurse that I have had since I was admitted that didn't say that I stink up the unit." I just said, "well, sometimes a good wash makes you feel better, and if you just have the right way to do it you can really clean your self up, but from now on, just tell them in the morning that you want a hot basin of soapy H20 with lots of wash cloths and to put it at the bedside. But as long as you feel better, I feel better."

ok had a pt. last night who needed a new PIV. The day shift RN told me he pulled it out by accident around 5pm...I asked her why she didn't put in a new one..she said no one could get a vein, even the MD. I said wel there is a STAT dose of vanco that should have been given at 5:30pm according the ID MD's orders, and the 6pm dose of zosyn was also not given, it's now 7pm, we are changing shift and are all the MD's aware that the IV ATBX weren't given due to no PIV access..the RN said yes...little background on the pt, he's a renal transplant in rejection and ended up on my floor (which is interventional cardiology) due to a hypertensive crisis during a TMA operation. Now, the BP is undercontroll and the MD wrote for the pt. to d/c tele, but because he's been through so much medically his veins were all sclerosed... So I went into the room, introduced my self tld the pt. I was going to try and put a new IV in...he said ok like a good sport... I looked at both arms to see if he had an old A/V fistula or shunt due to the fact that he had a kidney transplant...no A/V on either arm.... So I brought in 2 22g and 2 24g angiocaths... I tried the left arm first, got a great vein to pop after tapping for a while, I made the skin taunght and went to stick a 22g, and nothing, I was in the vein b/c th guywas so pale this veins were bright blue but no flash but I looked at the vein and tried to figure out why I had no flash and began to palpate further up the vein and felt this hard lumps all up and down the arm...so I retracted and went for the right arm...the pt. said to me, "that vein you just stuck, everyone always thinks it's great untill nothing happens, everyone get's that vein and then they are upset b/c it dosen't work" I said no problems, no worries we still have the right arm to try...he said, "one this guy stuck me and I never felt it and he was the only one who actually was the only one who could find a vein" I said, "gimme a chance you will be suprised" So I put the tuniquite on the right arm, and NOTHING, I began tapping away, and nothing, tap tap tap, then finally I saw something, plapated the vien up and down, grabbed the 24g and stuck the pt, BOOM huge flash, I said don't move, he said to me, "you are in the vein?, I didn't even feel it, let me see I don't believe it." I said look...he said "back flush it I can't belive it, that you found a good vein and you didn't hurt me and you got it on the 2nd try, the MD couldn't get a vein to save his life and he was the best..and those 3 nurses that stuck me today just made me have a bunch of holes in my arms wth no success. And now they wanna put a PICC in b/c they can't get a line ever, but you did thanks, and you did it and I felt no pain" I hung the vanco watched the IV ATBX run for about 5 min to make sure it didn't infiltrate and it was all good no blown vein, called the ID MD told him I got a 24g in the right wrist hung the vanco and will hang the zosyn later, he said, "you DID get a vein? How? This guy has no venous access b/c of sclerotic veins, I can't believe you got one on the 2nd stick." I just said, "well I just sat there and waited for something to pop, and got a great vein but put a small gague b/c I didn't want to blow the vein with a large gague while the 250mls of Vanco runs in and have it blow, I also noticed that the vein looks big but when I stuck him it would shrink so that's why I also used a small gague. I know we can't do much with a 24g PIV but run fluids but he now has venous access." The doc said thanks...and this morning before I left the MD actually came in early to see, I had the 6am dose of zosyn running it was susposed to be given q6 hrs so the day shift didn't give him him 6pm dose the night before, but he got the 12am dose and 6am dose ...he just said " I can't believe you found a vein that works"...the pt said, "she stuck me and I didn't even feel it, I like her alot" It's just pratice and patience, and you find your own technique of inserting PIV's. I tend to talk to the pt. and distract them while I stick them, it seems to relax them and they are less likely to flinch when you are taking to them about something. I hate when a pt. pulls back or flinches b/c you end up with a mess and you are more likely to stick your self..so what I found useful, I strike up conversation, get my stuff lined up as I am taking to the pt, and before they know it they have a working IV, and it also makes you the nurse more relaxed when you talk to the pt. insted of saying.."ok, I am going to insert the IV now..." I find that when I say that the pt. squirrms and moves and you blow the vein plus it makes you a little more on the spot b/c the pt is watching you every move... Some pt's like when you explain what you are doing, and are really into watching you which can be fun for you and the pt. b/c they are fasinicated and it's like Q&A time but is a learning exp. for the pt. and you as the nurse are teacching them.. but you also have to read the pt. before you stick them...I usually ask if they are going to flinch or squirm or pull away. Good luck, every nurse finds their PIV niche.

My fav. place is the hand...you just put that tourniquite on and tap away at the veins in the hand untill you find something. The pinky and the thumb work well for pt's that have crappy veins....but patience is key...just wait, and you can always use warm compresses to make that puppy pop..I also come with an orificenal of gagues in pairs...18, 20, 22, 24...so when that vein does pop you can look at it and det. the gague you need...once you stick just make sure the vein dosen;t roll before you stick...some people LOOK like they have good veins till you mmake the skin taunt then magically it disappers...just keep praticing..

I can stick the worst veins, start IV's on anyone, code a pt. , pull femoral sheaths, tell you about medications even hae MD's come to me about meds, can read rhythms when other people can't..but if you ask me to park my suv in a tight spot forget about it..I can parallel park like a pro which I am a total pro, but pulling into parking spots I am a total spaz.

I know those nights..one night I was bit by a pt. thank god she had no teeth, so she just gummed my hand literally..hahah..but she did punch me also. We have the boxing glove mitten restraints, they are so funny looking. But she did get a good crack in, then she bit, well gummed my hand. Another pt on a different night decided her room was too far from the nurses station s we moved her to another room with a roomate. She didn't like that room so the charg nurse told me to move her agian back to the original room she was in...WHAT A PAIN IN THE REAR...I was so angry with the fact that the charge nurse gave into this pt's manipulative behavior, pt. is a repeat offender or frequent flyer...So as we are moving her for the 3rd time, me and another nursing assistant are pusing the bed through the hall the pt. grabbs on to me for NO REASON..I told the pt. not to grab me while we are pusing the bed down the hall...she didn't understand the concept that the nurse, ME, and one nursing assistant are pusing a 500lb+ bed down the hall and not to grab onto the nurse who was ME, during transport. So the pt. literally grabbs me agian HARD, I am at the head of the bed pusing it down the hall, she grabbs onto my shoulder and took me off guard b/c I told her to not grab onto me, but she did anyway,she pulled me down as I jerked up and I dislocated my shoulder. I threw my arm back and made a windmill motion and the shoulder popped back into place. It didn't hurst at first, and it was early in my shift, but towards the end of my shift I decided to report it and go to the ER, spent my morning in the ER getting x-rays and well I was sent home in a shoulder immolibizer b/c I had dislocation. I ddn't take disability b/c I had about 6 days off work anyway and the MD said that's ok and if I had any major problems when I came back from my days off to come back to the ER. Thank god I had no major problems..the pt. wasn't confused at all, the pt. just didn't listen and she is notorious for exerting strength on nurses..I knew this before I had admitted her, from past exp. But no matter what I said or did I still was injured. On another awesome night, we had a confused CHF pt. pulling at his lines and he had a picc. We got an order for boxing glove restraints (soft mitten), he wasn't my pt., but as we were going to put the boxing gloves on, the pt. took a major swing at me, he got me good and knocked me over. This pt. woud just scream and curse al day and night. But he hit me in the ribs so hard I had this huge bruise. Once agian I had a pt. that pulled out her IV with her teeth and began chewing on it and spitting blood all over the room. I knew the pt. from previous admitts on my floor. She is non-verbal but a nightmare every time she comes in. All she does is mile at you then do something so outrageous. I admitted her, knew she was a confused cardiac pt. I left the room for aprox 5 min. I came backin and saw blood all over the floor, the walls, and the bed. I looked at all angles of the pt. for a bleed...nothing...I am like What the *** where did this blood come from..I mean it's all over the wals and on the other side of the room. I was so confused..then I look at the pt's mouth and see this little plastic thing dangling out, it's her IV, the angiocath, she's chewing on it and smiling. I said to spit out, she just knawed on it like a bone. I figued out that when the pt. ripped her IV out with her teeth she spit the blood all over the room. I removed it from her mouth, got a 1:1 order. I said to the MD on the phone, "My pt. jst pulled an interview with a vampire and pulled her IV out with her teeth and was found chewing on it" The MD came o assess her and saw the room and was horrified...yea when day shift took over, the pt. had a 1:1 and soft mitt boxing gloves, I was told that the 1:1 left the room for only a min or 2 and the pt. was found jumping on the bed trying to kick and bite...OMG...needless to say I was susposed to come back that night and called out b/c I was sick... I had another pt. tell me he was able to walk but upon standing he tried to take me to the floor with him..he said to me, "well I haven't walked in about 2 weeks so I figued you are a young nurse and could hold me"...what am I a olympic trainer who spots pt. for ambulation???? ahhhh....

We pull sheaths on my floor. I work Interventional Cardiology. The ACT has to be I can say that sometimes pt's come with ACT's in the 140's and I wish that the cath lab would have pulled it b/c now the pt's bp is elevated, very elevated and we can't pull, I have also had pt's with a baseline HR in the low 40's with a sheath that could have been puled in the cath lab and now Ihave to worry if then are going to really vasovagle on me. I have had pt's who's BP's have plummetted, hence the NSS gtt on stand by, and one time had to give atropine b/c the cath lab, or should I say PTCA factory, cranked out too many cases and were sending pt's untill 1am. A pt. had a sheath, they were too busy to pull it in the cath lab b/c they had to crank out the next case, sent the pt. to me with a ACT of 120..horrible let's give the pt. a blood clot...the HR was in the 70's, I followed sheath pulling protocol, called for my 2nd nurse to be present for the pull and well the HR went DOOOOWWWNNN to 19 when I pulled, the pt. stopped talking and the pt became diaphoretic imediatly, I grabbed the atropine I had tapped to the bed next to the IV site, gave it, NSS wideopen, pt. was fine with in a few seconds...the 2nd nurse was my help and witness. Let's just say I called the cath lab, the interventional MD and the cardiac fellow that did the cath and gave them a piece of my mind. But with any critical procedure, you have to be trained and know what to do. We have had 2 nurses holding pressure to stop bleeding, we have had MD's and nurses on top of pt. to stop hematomas..we have had it all....

So last night was a terrible night..ran around like usual. But I had this pt. who I had the previous night also. She's a Nephro RN and was on my unit for pulm. HTN and eval for lung transplant. So we got to talking the previous night and that's how I found out she was a RN. No one knew, which I found odd b/c our admission databases that we do for every pt. has their occupation/former occupation..the line was blank. So either the nurse who admitted her wasn't paying attn or no one asked. Any way... So we start talking, and I find out she's an RN at one of the hosp. I was thinking about transferring to in the past, that is owned by the hosp I work in now, she worked at one of the affiliate hospitals. Our healthcare system owns like 40+hosp and healthcare facilities. So we are chatting and she's such a GREAT patient, but very very sick... So last night I had her as a patient agian. She aske if I had anysleep in b/t shifts I said not really..she works nights also..we laughed..and then we started talking about how much snow we are susposed to get. Well she knew I live almost an hour away from the hosp. She said, "Ang, if the snows too bad in the morning, you can bunk up with me for a few hours just as long as you don't snore..." I just started laughing..so was she but she was serious...she began to tell me how she's been there since sometime last week and she still hasn't seen this cardiologist that was reffered by the lung transplant team. I said I will look who it is..I look in the chart, no physician referral form for a cardiologist...I began looking through her chart, which was HUGE, b/c she was transferred fromanother hospital for higher level of care...Ok I finally find out who the cardiologist is susposed to be...when I saw the name I almost dropped the chart.... Her Cardiac MD is the CHIEF of Cardiology..who I see at 5:50am every morning I work. He always has his flock of tele residents and med students with him. Great guy, and AMAZING MD. So I said to my pt. are you sure you didn't met him? She said no...hummmm.... Now this MD always says to me, "Ang for working all night and you run and make sure your pt's are very well taken care of all night long, you always look so put together at 5:50am after a long night of marathon running." yea yea yea I have been hearing this for almost 2 years now....I always fire back..hey I am young, drinklots of caffiene and when you arrive at 5:50am I am just starting my 4th cup of coffee so I am getting my morning buzz before my shift ends....anyway So I am in another pt's room at like 6:15a this morning trying to untangle this octopus of feeding tube lines, IV lines and O2 tubing. I see him walk onto the floor. I ran out of the pt's room and said, "are you going to see the pt. in room XYZ? I was told she was tentative or a RHC today as an add on case, I just want to make it a yes or no ans so I can tell her"...he says "well since there is a foot of snow on the ground I forsee an opening" I said "did you little magic cardiac ball tell you that, or did some of your outpatient patients leave a bunch of messages saying how they are not going to drive in 12 inches of snow, and to re-schedule the cath.." Now there were 2 surgons with him who looked at me like how dare you say that to him...and then he asks me how the pt. is doing..I give him the run down. As I am telling him about this pt. the 2 surgeons are scrambling to write it all down. He says, "Ang, I have sen this pt. but every time I see her she is sleeping, and she has met me before, she's just seen so many MD over the last few days..." I said..."Wait..ok did you know she's an RN at XYZ hosp?" He said, "No I didn't, but I am very happy that you just told me..." Now get this...he pulls me aside with these 2 surgeons, why they were with him I have no idea, and says, "Do you think the pt. is improving?" I said, "well over the last 48 hours that I have had her as a pt, she is ambulating more often, b/L breath sounds are much better, edema in the Lower extremities has marked improvement. Her O2 sat has improved drastically in the last 2 days." He said...."Now do you think her improvement is because or the Doctors, or the Nurses?" I said , "Since I had her as a pt. all weekend, and you don't make weekend rounds, but I give you updates on the phone in the AM on the weekends, I am going to say that it's the collaboration of health care professionals and communication that has improved her health." Helooked at the 2 surgeons and said, "this is the RN that all of my patients talk about months after they have left the hospital." So he brings up a story about a pt. I had like 2 weeks ago. It wasn't his pt. but he happend to be on the unit when I admitted the pt. from the ER at 5:55am. The ER never checked the pt's rhythm and sent the pt. to me in rapid A-fib..HR is in the 160's, I call the tele resident, she comes, dosen't know what to give the pt. He overheard me taking about the problem, and how I caouldn't get a single person on the phone to evl this pt. the tele resident was clueless. He comes over..and I say, "Doc can you please help me out, I have this pt. in rapid A-fib that just arrived about 5 min. ago. I need an order for..." He looks at the tele resident and his med studens and says ok gang what do we do for a pt. in rapid a-fib with a stable blood pressure. What ar the 2 drus we can give...some one says lopressor IV, yea if the BP was elevated adn the pt was in rapid a-fib but it was 110/50..some says Dig IV, ok good....he says come on guys what's the other med we give for rapid a-fib...they are all scrambling through their books...he says ANG, what is the other med we give? "Cardizem, there's the other drug so can I please get an order to either give her dig IV or start a cardizem gtt" He gave me a high 5 and said, "I knew she knew the answer that's why I stopped her from asking for the meds at first and wanted to see if you guys knew and how the 2 meds affect the body differently..." he said "ang what does dig do" I said "increases myocardial contraction, slows a-fib and a-flutter and proves to be ineffective in pt's with CHF...this pt isn't a CHF'r her K+ is normal her renal function is normal and her dig level in the ER was almost nill, so she was on dig at some point but she dosen't know" He looked at the tele resident who looked soo clueless, and said, "you can learn alot from this girl she's knows what she is doing..." So I got the order for IV dig stat and I also said "the pt's has never had a 2-d eccho, and nothing was ordered in the ER so can I add it on to the orders you just told me?" He said, "ang you know what to do..." and made me rattle off all the orders that I thought the pt. should have had but were not ordered..I began "OK, CXR r/o infiltrate, labs cbc bmp mg phos cpk trop flp, 12 lead ekg, 2-d eccho, cortodid doppler, ct of the chest, EPS consult...and a few other things, but does that sound about right?" His med students just stood there and stared at me...he said, "I think you got it.." I got another high 5. He's only like that with me and no ther RN's on the floor he grills me about pt's, meds and why we give them and blah blah blah and procedures. He said, "Now she's only been a nurse a little under 2 years,, I have seen her progress, and my patients love her. So never dismiss a nurses sugestion about pt. orders." I am thinking about going back and getting my APN in Cardiology. He aid he would write me a letter of reccomendation...the chief of cardiology...I know he does it on purpose b/c I am young, I am always willing to learn new things and he trusts me, and his pt's trust me...

what makes it hard as a first year nurse is learning the nursing culture and hospital culture and physician culture. Nursing school and clinical prepares you to BE a nurse in the world of nursing, with respect to education, clinical skills and knowledge. It dosen't prepare you for all the "extras" that come along with being a nurse. The first year of nursing is finding who you are as a nurse. You start out at the bottom of the barell...YOU ARE NEW. As with any organization or group, you have to find your niche. YOU have to FIND your NURSING VOICE. Which can take a while. Dealing with other nurses, doctors, staff ect..it can be very stressful and discouraging. If you have exp. working in the hosp. setting before you actually become an RN or LPN it helps and I wish I would have had that exp. before I became an RN almost 2 years ago. But that first year is a learning and building exp. People walk all over you, constantly question you, ignore you, ect...it's a breaking in period. YOu may get the most horrible pt. assignments, feel like crap and want to quit, cry, rant, and question why you ever became a nurse, BUT you end up having that epiphany one day that changes your life. Usually by the end of that first year or longer you find your voice as a nurse. You become assertive with people, espically MD's, which feels great when it actually happens. You begin to become more aggressive with nurses who bully you, which they begin to back off and respect that you grew a backbone. Also asking questions is OK!! All nurses no matter how many years exp. ask eachother quetions. We bounce ideas and questions off of eachother all the time. And most of the time some of the senior nurses are asking the new nurses things b/c the new nurses are fresh out of school with new nursing knowledge. And new nurses more so then normal ask quesrtions. That is a good thing. But as a new nurse don't act like you know everything b/c you don't. If you don't know what you are doing as a new nurse tell someone, that's the only way you will learn. Example...I have been an R.N. for almost 2 years. Lastnight I had to give liquid dilantin via peg..ok I know IV dilantin can only be given with NSS. I asked 2 other nurses that when I give it via peg can I give it with water or do I have to give it with NSS...they both said since it is peg it can be given with water but warm water b/c it is so thick..cool...another thing is as I was going to give the peg tube meds the peg wouldn't flush to gravity with just a water flush. I repositioned the pt, tried a push top toomby, nothing would work. I grabbed one of the other nurses and said I think the peg is clogged but I have't even given meds yet..my girlfriend said, you have to milk the PEG to get the gunk and sludge out of it. She showed me how to do it...GROSS we both flinched but she said now you know how to do it, almost 2 years as an RN and I am always learning, she also asked how they heck the day shiftRN gve meds via peg if it was this clogged..I said, no clue, but at least we can give the pt his PM meds. So we both realized a brand new RN had the pt. during the day and most likely didn't give the pt his meds b/c the tube was clogged and she didn't ask for help. Always ask for help, DO NOT try and do everything yourself. Even if you are ignored juust keep aksing. Someone will help you. There is a barrier that nurses have to break through. It's like being the new kid in school. Some of the poeple you meet at first you may hate and thnink what a witch, and no matter how nice you are those people may just be down right rude or mean to you for no reason or just be indifirent to you. Others you might think are lazifair and just don't care...don't ever judge a book by it's cover. Some of those rudemean witchy, lazifaire labels you initially have about people can be completely wrong. Infact 99% of the nurses I work with at night are the best nurses I have ever seen. There is only one who I can honestly say needs to not be a nurse. Recently a nurse I work with at night, who I thought for the last 2 years was burntout totally blew me away with her ICU knowledge and skills. She def. is a nurse that if I was an ICU pt. on my floor would want her to be the one calling the shots, but as a regular bedside tele nurse, I would not want her. Her ICU skills are amazing, maybe it's the 30+ years exp. she has as an ICU nurse, but her bedside tele skills and manor are burnout. But finding that blance as a new nurse is horrible. MD's yell at you, not all MD's, but you are barked at, you run in circles, you learn your delegation skills, you also HAVE to learn to SPEAK up for yourself. If you can't defend yourself or be Aggressive or assertive then you will have a problem. You can be both aggressive and assertive and still be nice, and at times you can be both with out being nice when the situation calls for it. If you have tried the nice aggressive and assertive with MD's and they don't want to eval. a pt. at 2am b/c they don't cover the pt's attending MD, and the pt. is havig a problem and you need an MD there NOW, you drop the NICE and BECOME VERY aggressive and assertive, b/c it's your resp. to your pt. if there is a problem for an MD to eval. the pt. You may get the run around quite a few times as a new nurse and not know what t do..but once you grow the nurse backbone which takes time, and say I need an MD here NOW to eval. this pt., someone will come, they may not be happy but they will come. Nursing is being compassionate, learning how to deal with people, doctors are people too and may be intimidating but they have the same resp. as you, tey are there are the pt., they may make you feel like a peion but they know with out nurses that there would be a major problem and they do apprecitate you. Nurses eat their young for a reason, to make you a nurse, and it's usually to make you a good or a great nurse, you need to learn ad exp. difficult assignments for prioritizatrion and delegation and just to have knowledge. If we were all babied as new nurses and given easy assignments and didn't learn how to become a voice then nurses would not be who we are. I have seen new nurses that were babied and given easy assignments and a year later those nurses go crazy when they have multiple probles going on at once, and I help them out. but I ask my ANM at night why they were coddled and given easy assignemts and why I wasn't treated like that my first year of being a new nurse. They tell me well, we saw strength and we knew you could handle the hard assignments, HUH? I was a new nurse like them when I first started what made me different? They saw, what both of my ANM's at night have said over and over, "We saw a brand new nurse that was good and is going to have the potential to become a great nurse, and well now we made you a great nurse and you still have even more potential." After more abuse and crap that any new nurse on night shift has ever endured, I was told, I survived, and for that I actually thank them that I wasn't babied. We are strong, we are the pt's voice, we spend more time with the pt. than a MD ever will. Nursing takes a type of person that has a heart, a really good sense of humor, patience at important times hahaha, can't take what others say to heart and let it offend us, although we do, we cry with our pt's, we cry when we get frustrated, we don't sleep, we hold a pt's hand when we see the desperation in their eyes no matter how busy we are, we make people smile, we run in circles our entire shift, we save MD's butts hahaha, we teach and educate, we become a family, we become our family's personal doctor ahaha, we deal with alot of stress, we have people talk down to us and belittle us, we have pt's bite kick spit and punch us, people think we are glorified maids and gofergetters, people think we know less then we actually do untill we answer their questions that the MD's couldn't answer, we are medical McGyvers when it comes to patient care, we are ingenious and can figure oiut how to fix most anything with tape and other things. We are guardian angels, we are nurses.

just had my first problem with this recently. I was pulled to another floor for the night. I have been on this floor many times before so I knew the nurses. I pulled my 10pm meds from the pyxis. I went to give my pt. 0.5mg of xanax and when I did the bedside check of the med before I administered the med I noticed I had a 0.25mg of xanax still in the pill pack. I always do multiple med checks before I administer the med. I said to the pt. I would be right back. Took all of the pills I had for 10pm meds still in their packaging and went back to the pyxis I pulled the med from. I logged in, brought up the pt and the meds. I saw the xanax 0.5mg on the screen profiled for the pt. it was the ONLY xanax order for the pt which I made sure and even checked the chart 2 times, I touched the xanax 0.5mg on the screen and the drawer opened, the cubie pops open and I pulled out what was susposed to be 0.5mg of xanax and checked ALL the pills. Yea there was an awesome mix of 0.5mg and 0.25mg of xanax in the same cubie. Ok since this is NOT my regular floor, I made sure I checked what I was doing like 4 times. I said to the charge nurse there is a problem with one of your pyxis in the back. Now this floor has 3 pyxis machines. I showed her and 2 other nurses the med problem. I explained that I pulled a 0.25mg of xanax from the 0.5mg xanax cubie and showed the charge the ridiclous mix of 0.25and 0.5 xanax mixed in the same cubie. We went into the med log in the pyxis to see if someone retured xanax to the wrong drawer..NOPE. The last person before me to access that specific cubie was the pharmacy for med refill. What a pain in the rear. We had to call the pharmacy and they had to come reconcille the problem. We had to check all 3 pyxis machines to make dure that the 0.5mg and 0.25 mg xanax were in the correct pockets in all 3 pyxis machines. Now this was well after shift change and narc counting that was done at 7pm. It must have happened when they did the med pocket refills around 8 or 9 pm. All 3 pyxis machines had the same problem with xanax, they were all mixed up. 0.5 and 0.25 were in the same cubie. The person who must have refilled them must have gotten the two dosage strenghts mixed up or wasn't paying attention. Even the nursing supervisor at night had to come and see what happened. THANK GOD I ALWAYS double and triple check my meds before I administer them. The chrage nurse on that floor said to me..good catch Ang, I can tell your director that you discovered a major med. error b/c you are an observant and great nurse for catching something that could have been a major problem. I said thanks, but also thought, I know sometimes we rush through med administritation b/c we may be be behind or just trying to give them on time, but how many of us just pull from the pyxis, assuming the machine is right and just give the med with out actually looking at the packging, or just give a glance at the packging, ok it's the right med, but don't really pay attention to the dose? We just assume that the med in the pocket that flipps open is the right med, or dosage? One thing I have learned is always check and re-check your pt. meds no matter what.

soo sorry to hear that. My biggest help in anatomy was getting a study group and just drilling the crap put of each other...it's just memorization. another thing is I made a binder of all the slides and pictures for my lab practicals and just kept going over them over and ove. Another thing is if you have a study group you can come up with some great anagrams and stuff..I mean we had some very dirty raunchy ones but I will always remember my cranial nerves to this day..just keep it up ..A&P is difficullt but just keep memorizing!!!! It will click. Ithink I bombed my first anatomy test too..and I SUCK at taking tests but just remember A&P is your roots..I use them every day I work. Good luck and if you need some pointers let me know..also don't read TOO much into your A&P text book..there's alot of WORDS..just ask questions, talk to your teacher and if you are disecting the cat it's the best learing tool. Hope ya nail the next one!

Dansko's if you can tolerate the "breaking in" period, but once boken in LOVE EM', hence the reason I have 7 pairs in all diff colors and styles, A good stethoscope, the Littman Classic II S.E. I have had for 4 years and it's amazing. I pick up breath sounds that other nurses can't hear. Also gives great S1S2 sounds, you can actualy heary the gallop or ken-tuk-y sound. And clear bowl sounds, you don't have to spend time in dead silence for bowl sounds. Good scrubs. And a short sleeve matching scrub jacket...more pockets Cherokee makes great long sleeve t-shirts for the winter time. Thin socks, with re-inforced stiching at the toes, if not you will be buying new socks all the time. The ACLS Pocket guide A GOOD DRUG BOOK...Nursing 2006 which came out in 2005 is the best drug guide I ever had, infact I beat mine up so much in school, that when I graduated in 07 I had a 2nd copy. Nursing 2008 is not any good try Nursing 2009. I hate anyof the other drug guides, they give little info, and are missing all kindsof meds. The Nursing 200whatever drug guides give you so much info. I have MD's use my drug guide. Have a quick refrence book for Lab's, Diseases, and tests and procedures. There is a series of books that are quick refrence guides called Nurses Quick Check by Lippincott, I have about 6 Nurses quick Check, labs, lytes, disease process, fluids, ect...ALSO have a great Medical cyclopedia at home. I have Tabers..Love it. Pocket refrene guides like RN notes, or Nursng PD are good for orientation and good to have in your locker at work. Also any ER nurse should have a Emegency and Critical Care Pocket guide 5th edition by paula derr. PDA's are ok but if you drop them in something that's well a human bodily fluid you risk the chance of ruining the PDA, where as a pockey guide you just wipe it off and keep going. Also you don't have to charge a pocket guide. A PDA has to be charged, so if it's a critical situation a ACLS pocket guide won't run run out of batteries, but a PDA will... Invest in oxyclean for when you wash your uniforms. Invest in a stain stick for your uniforms, and you may not know what that dime size stain is or where it came from. A good bag to take to work, esp. as a new RN. YOu are bombarded with papers and crap, along with all of the guides you may carry. After time you know what to have with you at all times in you bag, and books or papers to keep at home or in your locker. A GOOD Cardiac Rhythm BOOK. And something with a picture of how to do a 12 lead EKG (keep in bag or locker for quick refrence). It's amazing how many nurses do not know how to do a 12 lead EKG. A GOOD WATCH. I have a swiss army watch that is now discontinued. This is my second one of the exact same make and model. It's a rubber/silicone band easy to clean, with a big watch face and both regular time and military time and a huge sweeping second hand. I get compliments on it all the time. Infact My aunt who is an ER nurse with30+ years exp gave me my first one when I was in Nursing school. She loved it so much my mom and I bought her the exact same watch. When I started my first job as an RN the band snapped due to major abuse while I was in school. I bouht the 2nd one on e-bay b/c it was discontinued by swiss army. the orig. price was 400 beans, but the second one I bought on e-bay, same exact watch was only 100 beans. DO not be afraid to spend money on a GOOD WATCH!!! A slicone band you can clean, a cloth band hold skin, mildew, and god know what else, and a leather band is just gross looking after the first time it gets wet with water. Always have military time and a sweeping 2nd hand along with the date on the watch. Never a digital watch. Umm good pillows and sheets and room darkening blinds and curtains. And always have coffee, water or tea!!!

CALLER ID AND AN ANS. MACHINE so you can hear them leave a message asking what they want from you. I also have digital voice mail from telephone service provider, but never set it up b/c I want to hear what work is saying insted of having to dial a # to hear the message, based the ans. machine message I can hear from my bedroom, I'll pick up the phone or avoid it like the plague.

I work in the same exact setting. I have been on my floor for a year and a half. I would love to get a job on CTICU, I have been pulled to CTICU and loved it . But as of late all of my fellow collegues have been telling me I belong in the ER. Not the ER at my hosp. but a level I trauma center. But even having 1.6 years exp. in interventional cardiology/ccu stepdown unit I am always learning. I think that tele is a great gateway nursing exp. I am the one all the night shift nurses come to to ascess if there is a suspected problem, I am also the one who will call the MD and make sure some one sees the pt. no mater what time it is, even if it's not my pt. . With only 1.6 years exp. and I am having nurses with 20+ years exp. asking me to give an assessment before the MD is called or a code or an RRT, makes me think if Ihad 3 years exp. I can go to what ever critical care setting I choose, with the exception of Peds and L&D. But go for it! Tele is a great place to have exp.